Expert: Claes-Gustaf Nordquist, M.D. - 1/26/2009

Question
QUESTION: I had the tumor removed in a very successful surgery but the doctors say there may still be pieces left in my head and want me to undergo chemo and radiation.  I am very concerned about the side effects of both along with the fact that Ive been told that the chances of it working are not very good anyways.  Should I do the treatment or not?  Could I wait to do treatment until I see if anything is still there?  What about doing just one treatment or the other?

ANSWER: What kind of brain tumor did you have? Without knowing the full pathology it is more or less impossible to give you advice.


---------- FOLLOW-UP ----------

QUESTION: Sorry its a level 3 astrocytoma.  Is that enough or do I need to go get more specifics?

Answer
The prognosis of a brain tumor is linked to its GRADE (what you here call level). The higher the grade the worse the prognosis. Grade runs from 1 to 4 where grade 4 then obviously carries the worst prognosis.  Both grade 3 and grade 4 are usually called the bad grades since the prognosis of them both differs markedly from the prognosis of grades 1 & 2 which are much less severe. Grading is done by the pathologists that diagnose and evaluate brain tumors by what they look like in a microscope. That is a VERY hard and difficult thing to do and is usually done by several very talented and experienced pathologists working together as a team trying to conclude how to define a particular brain tumor. Even so now and then the diagnosis and even more so the grade is uncertain and mistakes are done usually showing up as an unexpected prognosis in reality ( by the patient living longer or shorter than expected). You have - it seems - the misfortune of having a grade 3 tumor. It is likely that the grade is correct but it is possible that it in fact is incorrect. If that is a fact then the chances are about even that it is a grade 4 (worse) or a grade 2 (less bad). These chances are not big but they exist. They are different for different groups of pathologists too so I do not even dare to guess what they may be in your case. So in case your grade is incorrect you have an even chance that it is a grade 2. A grade 2 case can live many years after full treatment. A grade 4 however will probably live around one year after full treatment. In conclusion I can only give you the advice to accept full treatment since it may give you - as described above - the chance of living several more years. But of course I can not promise anything. In case your tumor IS a grade 3 or even a grade 4 you will anyway not be much worse off by this treatment - in fact it will even then make you live longer but not by much. However the choice is of course yours and yours alone. I only give advice. So the information you gave me was enough. Thanks! I'm sorry I have nothing better to tell you!